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Traumatic brain injury (moderate to severe)

Laesio cerebri traumatica · Traumatické poranění mozku (středně těžké až těžké)

What it is

Brain damage from a blow or sudden acceleration — falls and road crashes — with bleeding, swelling and raised pressure; a leading cause of death and disability in young adults, and ever more in older people who fall.

Symptoms & signs

  • Loss of consciousness or confusion
  • vomiting, worsening headache
  • unequal pupils
  • seizures
  • weakness or loss of speech
  • later: memory, personality and mood changes

🚩 Get help if…

  • call 112 / 911 now Knocked out, or drowsy and hard to wake after a head injury
  • call 112 / 911 now Repeated vomiting, a seizure, or one pupil bigger than the other
  • call 112 / 911 now Clear fluid or blood from nose or ears, or bruising behind the ears
  • see a doctor soon Headache, confusion or memory gaps that get worse over hours

Where it strikes

Medical treatment

  • CT scan; Glasgow Coma Scale
  • protect airway, oxygen and blood pressure
  • surgery to remove large haematomas
  • intracranial pressure monitoring and control
  • Tranexamic acid within 3 hours — CRASH-3: no overall difference in head-injury deaths, fewer in mild-to-moderate injury mixed evidence
  • Decompressive craniectomy — RESCUEicp: fewer deaths, but more survivors vegetative or severely disabled mixed evidence
  • Steroids — CRASH: more deaths not confirmed in trials
  • Cooling the body — no benefit not confirmed in trials
  • rehabilitation

Natural & lifestyle

  • Helmets, seat belts, fall prevention in the elderly
  • no alcohol
  • graded return to activity in rehabilitation

Emerging & experimental

  • Blood biomarkers (GFAP, UCH-L1) to spare CT scans
  • stem-cell therapies
  • Progesterone — two large trials negative not confirmed in trials

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Hyperbaric oxygen — small trials in chronic injury disagree mixed evidence
  • Omega-3 (DHA) — animal studies early / small studies
  • Creatine — small trials in children early / small studies

ICD codes